Functional Spec Template - Kimberly Lovely



2010 Usability ReportInternal Use Only DATE \@ "dddd, MMMM dd, yyyy" Thursday, July 08, 2010Change ControlRelated DocumentsDescriptionFunctionLocationNeighborhood Health Plan (NHP)NHP Field Study PlanField Study PlanSharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsDebrief WellPoint & NHPRecapping usability observationsSharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsNHP Notes from studyCollective notes SharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsBlue Cross Blue Shield of TN (BCBS of TN)BCBS of TN Field Study PlanField Study PlanSharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsBCBS Notes from studyCollective notesSharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsBCBS of TN DemographicsResults of the survey from usersSharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsBCBS of TN InterviewsResults of interviewsSharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsQuotes from CustomersCollection of quotes in my usability travels to customer sitesSharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsIT Problems Reported from Value CaptureValue Capture observationsSharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsValue Capture log descriptionWe went over this spreadsheet in our meeting with BCBS of TN and Value Capture of IT problem logsSharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsBCBS of TN Workgroup Session Results3 hour collaboration with user on three exercisesSharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsNumber of Case Manager Users using CASpreadsheet with the total number of users by line of businessSharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsWellPoint2009-2010 Call Handle TimeCall handle times in secondsSharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsMaster QuantifierThis document is an inventory of all Lean UM Quantifiers.SharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsTraining Notes for CM & UMNotes taken while observing the CM & UM folks for the week.SharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsUM Testing with WellPointTesting results with WellPoint done for UM 4.7 designSharePoint CAE 4.8 Release/ Usability/Usability Plans/2010 Usability Report/SupportsChange RecordDateAuthorVersionReference5/25/2010Kimberly Lovely1.06/04/2010Kimberly Lovely2.0ContributorsNameNameNameKimberly LovelyJulie KingJosie BaileyDeliverable Review/Sign-Off RequirementsRoleReviewerSigned ApprovalDateN/AN/AN/ATABLE OF CONTENTS TOC \o "1-3" \h \z \u Clients Studied: WellPoint, NHP & BCBS of TN PAGEREF _Toc262566392 \h 6The Field Study Story PAGEREF _Toc262566393 \h 6Understanding Our Users PAGEREF _Toc262566394 \h 8Demograpic Questionnaire Results PAGEREF _Toc262566395 \h 9Identifying Usability Issues & Inefficientcies (Findings) PAGEREF _Toc262566396 \h 27Interview Respnses from Supervisors & Care Mangers PAGEREF _Toc262566397 \h 32Closing Remarks PAGEREF _Toc262566398 \h 48Friday Workgroup session - notes PAGEREF _Toc262566399 \h 50Value Captures – Reported IT problems PAGEREF _Toc262566400 \h 62 2010 Usability ReportClients Studied: WellPoint, NHP & BCBS of TNDetails of the usability report.NHP – March 29th – March 30th, Resumed on May 21st, May 27th and June 15th, Kimberly Lovely, Kristie Donnellan, Janice Mead and RohitWellPoint – March 22nd – March 26th, Training, Janice Mead observing UM training, Kimberly Lovely Observing UM and CM training.BCBS of TN – April 26th – 30th, Josie Bailey, Julie King and Kimberly Lovelythe Field Study storyWellPointThe WellPoint one week training I observed was a mixture of UM and CM supervisory roles. CM users were not extreme power users like UM folks. They really aren’t measured but soon will be they stated. They mouse clicked and took their time. Whereas the UM users were power users tabbing forward, backward, using the mouse right click, and the arrow keys to navigate from field to field. UM users are highly measured. “It’s like going from a Yugo to a Beemer.” - CM student“The product is over engineered in places.” – UM Student“There are a lot of moving parts.” – UM Student“To many places to look for the same thing.” – CM StudentNHPThe NHP site visit was with users in supervisory roles and care managers. First two users work in Content Editor and the third works in the product 50 percent of the time. The forth user works in the product and is a true end user. 8 Care Managers and two supervisors were observed.“We tell everyone that they are forbidden to use the back button in the product.” – Martha Badger, CM & Content Manager“There are a lot of thing we don’t use or is completely useless to me. We may not be using the product like it was intended.” – Laurie Farquharson, CM Pediatrics“It’s floats! It scales!” (She didn’t know the Member Overview icon floated)– Laurie Farquharson“It’s so easy to do something wrong in the product.” – Martha BadgerBCBS of TN Out of these 366 users only 21 of them are men.BCBS of TN was breath taking. A fortress up on the hill along the banks of the mighty TN river. Will these CM users be like the users observed thus far I wondered? It will be interesting to see the three lines of business Commercial, Medicaid and Medicare all under one roof and in one state. I have already met my users prior to landing. I received many demographics surveys and questionnaires back from them. The TriZetto team started the week off with first Commercial, Tuesday Medicaid then Thursday a two person interview with Medicare. Medicare opted out of the observation part of the study last minute. In the morning Care Manger Supervisors came down from each line of business. The forum was round table discussions and a Q&A session. Next we split for observation of the end users. Thursday we met with Value Capture to go over their findings which were minimal and mostly resolved upon an upgrade to 4.7. The most exciting day was of course the Workgroup session. This is where we discovered we had an innovative bunch of folks. We witnessed the birth of AWESOME 2.0.Details of the work group sessionWe invited the users we studied to this session to gain the following:1. To learn how they would ideally like to assign members.2. To understand how they would ideally like to design a Care Plan.3. To collectively understand what they would like to see on their personal Dashboard (Homepage).The TriZetto team was armed with cards for them to work with. However they did the opposite. They took matters into their own hands. I guess by telling them that they have to create it from scratch ignited the flow of innovative thinking. They were told that nothing existed out there. There was no care Advance or Facets in there world. It was up to them to create their “Blue Sky.”What we learn was they like to spend BCBS money for touch screens and voice recognition technology.Care Managers are like no other user I have ever observed before. They carry a heavy heart and it’s personal to them. They take on the member’s stress. They comfort families whom lost a love one. They are resourceful and make sure members are educated. They do not work 9-5 but 24/7. On the weekends they drop off toys for the children of the dying parent. These Care Mangers care for you and your family.I think the reason why many or all of us are at TriZetto is to make a difference in the health care industry. This is a commonality we share with our Care Managers of our product. 1. Understanding the usersWith that said I would like you to met Patricia. Patricia out of all the users of our product struck me the most. Her confidence and style on how she works with her members caught my attention. Patricia is very computer savvy but set in her ways. Patricia starts her day off by launching Outlook to check on her mail. She launches Word, Excel, Facets and Care Advance. She has been using CCA for 1 ? years now. Her role is dual, she does the UM case for members seeking bariatrics surgery, which is a process, they must meet several goals before the surgery is approved. Once they have the procedure, she follows them in a Care Management case long term to help ensure success of the procedure. She may have 2 years worth of data per member.50 percent of her day is going on the hunt for the member’s phone number. She has her methods to hunt it down which varies from each user. But her main goal is to care for her member’s. She first tries Facets. No luck. So she launches a template for a form for missing phone number. She has to reach this member within 7 days according to the business process. Knowing that in 24 hours this maybe resolve is comforting to her. However reaching that member is delayed one more day.When she is creating a Care Plan it’s all in word. She copies from word to CCA. She is more comfortable and productive in doing so she states. She is like many that I have observed in Care Management. Many feel they are doing the same task over and over for 30 minutes when a simple task should take less than 5 minutes. An example given was of something that is so simple but takes them time of having drop downs for a selection in alphabetical order. Condition list and medication list you can’t sort alphabetically. Another example was the ability to select multiple milestones at a time to import into a Care Plan. In conclusion in observing Pat and the others we are seeing a pattern that is worth noting. The system is creating a behavior in the users. The behavior is one of trust. Many have lost important information and time entering in notes on a member when the system would quit on them (Citrix). So they rely on a self generated paper base system or they record in notepad and or word. They enter in the information ONLY after they have captured the information needed of a member in these aids. This is duplicating the workload for the users and doubling the amount of time doing the tasks.The users want to be as efficient as possible and feel the product wastes a lot of their time when not necessary. Time they would rather spend with more members.Users expect technology to be integrated into the product to enhance their workflow. Our users are savvy and would love to use right click menus, drag and drop capabilities, tear off tabs to enable them to work on more than one member at a time.“My job should be to work for the member not the documentation.” – NHP , Care Manger2. Demograpic questionnaire results33 questionnaires have come back so far from our users whom are all female except for one. They will continue to trickle in. These results are from BCBS of TN. A consolidation of those results can be seen below.Education — level of schooling our users have completed. (33 respondents)Users were asked: What level of schooling have you completed?Training on CareAdvance Users were asked: When were you trained on the product, what version of the product and for how long was the training? What we learned from this question was that training varied. NHP and BCBS of TN users felt that they could use more training. The range of training was from 2.5 days to 2 weeks. Some training reported consists of PowerPoint Presentations or webinars for 1 – 3 hours. Mentoring also took place learning from others on their team the product. Cheat sheets where also created by Care Manager Supervisors to expedite efficiency in workflows and aid the users starting out in the product after training.Job role length of timeUsers were asked: How long have you been in this role?The majority are seasoned in their current job role.Total years of experience our users have in the healthcare industry.Users were asked: How many total years of experience do you have in the healthcare industry?What we discovered was the majority of the users had ten plus years in the healthcare industry. So they are educated and very experience in their field.User Self Rating in CareAdvance.Users were asked: How would you rate yourself as a user of the CareAdvance Product? Novice, Average or an Expert?As we have discovered in previous questions these users have been using the product for a long period of time. Many factors come into play as to why they only feel that they are average users of the product. Lack of lengthy training as noted may be a key component. As observations were made of users in the product they seem sluggish in comparison to other products such as word or note pad. Certain tasks in the product were interrupted by resorting to tangible aids for task completion.Tools & Technology used in our user’s work.Users were asked: What tools and technology do you use in your work? (Please include any software tools, as well as phone, PDA, paper forms, equipment, number of monitors etc.)Software/TechnologyPaper Based ToolsEquipmentCareAdvanceCM Checklist(1- 2) 19” Monitors Facets, QNXTPaper FormsPhone/Headset/BlackberryTriage LogNote PadsComputer/LaptopSharePoint (Triage)Paper FormsCalendarOutlookFoldersKeyboard/MouseWordFacets Face SheetModem/Comcast w/Nortel BoxExcelDrug HandbookPrinterNote PadCover TN HandbooksScannerJuniperTransplant FormsDesk/ChairThin ClientSharePoint Member InfoFaxRight FaxPaper AidsCoping machineCareGuidePolicies & ProceduresCalculatorAmysis look-backRolodexCITRIXMEDAI DatabaseHCS Provider ViewerPeopleSoft FinanceCare GuideLive MeetingBC Member Appeals AutomationCarekey BridgePowerPointLanguage LineFEP DirectReport ManagerNext Gen CMGenesysCM Referral DatabaseXenDesktopSnagITPersonal TemplatesInternet/ Browser Government SitesAccess CareGuideGoogleNHP IntranetHealthwiseSmart NeighborDCS WebsitesIntranet / BCBST Sites, Crossroads, WindowsIH250, IH728 Main FrameIt was interesting to see that each Care Manager had a tangible folder on each member they cared for. This folder contains the Facets Face Sheet, written notes, printouts etc. Many users went outside CA to sites that aided task completion. Medicaid users spend 50 percent of their time hunting down phone numbers. In doing so they went to and some Googled the names. Other sites users went out to a lot were as a direct result of CAE not having a usable search for drugs and . Tools such as the calculator were used to do cost savings tasks. A widget would come in handy that they could use in this type of task.Monitor Resolution and size.Users were asked: What size are your monitor(s)? What monitor resolution are you viewing CareAdvance?The size of the resolution varied based on the setup in home offices and in the office. The physical size range of the monitors was 11” to 24” in size. Some users work just off their laptops. The recommended monitor resolution based off the user guide is 1024x768. What we found also is that even at the recommended size of 1024x768 the users were still scrolling horizontally which is causing strain on the wrist. This is an important point to make as WellPoint has a strict accessibility policy for workmen’s comp. Unfortunately not all users adhere 1024 also. Having the resolution at 1280 causes a void and waste of space. Majority of the users were viewing CareAdvance in 1024 and 1280. There were some at 1154 and 1440. The screen layout should be liquid both horizontally and vertically.VOID – As a result of having the resolution at 1280 there is an empty area created. Liquefying the layout would serve beneficial.1280 x 1024 Monitor Resolution1024 x 768 Monitor Resolution – Even at the recommended size the tabs below are cut off and a scroll bar is added to the right. This also may explain why users are not using the tabs at the below. Keeping everything above the fold will reduce the scrolling. For many users they don’t have the top browser bar but have to scroll horizontally also which is straining them. Users are having problems with their wrist will all the scrolling.1152 x 864 Monitor Resolution – Users have adjusted to this resolution perhaps because the layout shows the tabs below and eliminate the scroll bar to the right.Loading all the tools also in the browser menu bar takes up time and adds to the visual clutter. The recommendation is for no browser bar at the top. Use open window method only. There is no value to the user having this at the top. In fact the browser back button is being hit. This causes error messages. Some users also are using right click back which also causes the same issue.Right Click Contextual Menus & TabbingUsers were asked: Do you right click with the mouse in applications? Example would be for menu items in Microsoft Word. They were also asked if they tab into fields with the keyboard. The goal of this question was to see if contextual menus for the right click function would be intuitive to users of CareAdvance. We discovered that most of the users surveyed use right click contextual menus for functions such as cut and paste except for 5 out of the 78 surveyed. They also added they can’t do that in CareAdvance and would love to see that functionality integrated.For the tabbing field to field only 8 out of the 78 surveyed said they don’t. So what this is telling us is that the tabbing in the product has to work and work logically to support this behavior in the user’s workflow. It is also an accessibility issue and with WellPoint a workman’s comp. compliance issue as I noted in the WellPoint UM testing documentation.Ages of our usersUsers were asked: There age range.The majority of the users surveyed are between the ages of 36 years to 55 years. The youngest 13 users were 26 years – 35 years of age. The oldest 13 users were 56 years – 65 years of age. There was one user in the age group 18 years – 25 years of age.Eye SightUsers were asked: Describe your eye sight, Good, Okay, Poor or 20/20, 20/25, 20/30, 20/40 etc.The majority of the users surveyed had okay vision with the help of glasses or contacts. Only ten users had 20/20 but they had 20/20 vision mostly with corrective lenses. In observation also I asked these questions again when they were working because I noticed them squinting and moving forward with their body to the monitor. It’s funny when you see this behavior then ask them what their eye sight is. A lot of them say oh my eye sight is perfect. Then the body language says the opposite.Job aidsUsers were asked: Describe what aids your job outside CareAdvance?The following is a list of those aids:Facets & Facets Face SheetQNXTPNC Reporting ToolCo-workersReports that are ranCalculatorNote PadIH728, IH250TCRTSearch EnginesMeetingsConsultationsContact List on NHP IntranetPatient Focused meetingsEducational conferencesMedical Conferences Medical references and periodicalsCommunity ResourcesSmart NeighborTemplates for referral to the Asth,a Home ProgramThe NIH Asthma EPR-3 GuidelinesFEP DirectCM Referral DatabaseMicrosoft Office (Outlook, Word, Excel, Access and PowerPoint)Medical DictionaryTopical conference callsNewsletterAdvocacy networksWebsites:NEHENTN AnytimeEncoder ProIntranet (BCBST Policies & procedures, CM Workflows, P&P’s etc) Milliman, CareGuideGenisysPeopleSoft FinanceHCS Provider ViewerImaging & Right FaxNext Gen CMGenesysIgenix CoderUsers favorite sitesUsers were asked: What are your favorite websites?Search Comments: It's very easy to look up medications, medical conditions, etc.Use Google to research a new medical procedure or medication to familiarize myself with themGoogle scholar Search for medical info research Medical Resources for educational supportComments: They have accurate information. Medical-Web MDI can access it and google to look up info not found in CareAdvance, many drugs not found there.Fast, user friendly, easy to navigate Comments: Website for medications. Assists with looking up unfamiliar medications. American Cancer Society site. Good resource for members. Up to date information on health and medications HYPERLINK "" Medical Policy RulesTennCare exclusion list TennCare Quick guide Medical Abbreviations Approved to use County information BMI Calculator Weight calculator Height calculator Creatinine Clearance calculator Medical abbreviations Research meanings of medical abbreviationsDrug interaction checker Rand McNallyMileage info for member reimbursment RX list for medication information Transplant information AccessTN specialty drug info Air ambulance info National Institute of Health clinical trials Clinical Trials listing service TennCare Contractor Risk Agreement Online conversion Convert just about anything to anything else Online. CPT codes for medicai tests Disease database Doctors guide Food and Drug Administration FDA - medications Drugs E Medicine from web MD Health gradesHealthcare rating Lab tests results and info Rates healthcare providers Medical library of the National Medical society Tenn Dept of Health Licensure verification Medical LexiconDictionary, medical news, medical abbreviations Medical info from the US National Library of Medicine and NIH MELD PELD calculator for transplant Quackwatch guide to health fraud VSHP Resource contacts Encoder pro,Drug information,American Diabetes AssociationMass. Department of Public HealthOther ResourcesUnited Way website. Good resource site for Can find benefits and rulesOffice of Elder to date information on Resources for nutrition, drugs-great resource for looking up medication information.TNAnytime They all help me to do my job faster and Workflows Bureau of TennCare To find out whether the TennCare Bureau has member listed as eligible, and what MCO the member is with, has been with or will be covered by, as well as alternative forms of coverage. Salary info Superpages For phone numbers Transplant info for patients Bomb Threat Call Checklist rx.State Department of Childrens Services MapQuest Helps with locations and dirctions for members and providersBC member appeals To find out what is going on with appeals for my case CommunityServingsMassHealth Cover TN info Case Management Resource guide Case Management Society of America Center for Disease Control Intranet sitesMedical Policy website for BCBSTFor looking up current medical policy, Milliman GuidelinesHealthcare Services Website, BCBST website for CM policy/proceduresHelps, and workflowsIt provides member information regarding in network providers and other useful information for members.Crossroads Because I can go to so many other sites from thereBC Online help BCBST Find a provider DME guidelines Language line To interpret incoming and outgoing callsImportant phone numbers BDCT Transplant centers and informationProcedures requiring prior auth BDCT Attachment A For AccessTN transplant members Personal SitesLocal and national This site does not apply to the job but what I like about it is when I place my cursor over the catagories at the top it branches out underneath. Once I hold cursor on one of those categories it branches out underneath for more specific information. I only have to go where I want to and do not have to make multiple clicks.Favorite Colors & Social NetworkingUsers were asked: What are your favorite colors? Do you use social networking sites?The users surveyed were almost equal in numbers on usage of social networking sites. 35 said they were not and 29 said they were. In the workgroup session we heard ideas such as I want to be tweeted when a member is in the hospital. Again out of 366 users at BCBS of TN & 60 at NHP of our product only 64 responded to this question. In 5 years we could see more social networking usage among our users as the next generation of nurses is hired.ColorsSocial Networking SitesGreen/Celery/Dark Green/Sage Green/ Neon Green/ Sea GreenFaceBookBlue/Royal BlueTwitterPeachYellow/ Gold (Local & International)Purple/LavenderPinkRed/Burgundy/Dusty RoseBlackBrownBurnt OrangeEmerald/TurquoiseFushiaGrayWhiteOrange5. Identifying usability issues & inefficientcies (findings)Restrictions in the current systemOur users are innovative and savvy on the computer. They ability to multi task is essential in the workflow of nurses in general. We discovered that they need to work on more than one member at a time. Having multiple members open in perhaps tear off tabs would be a solution. Users get call backs from members with data they need to enter in. However they are in the middle of creating a care plan for another member. The current system restrains the user to only work on one member at a time.“I should be assisted by my Care Management system and not prohibited by it.” – NHP, Care ManagerCare Plan attached to the Member NOT the CaseCare Plan needs to be, in the end, attached to a member . Currently in the system the care plan is attached to a case, which agreed, there is an association of a case to a care plan, however overall a care plan should be member based. A health practitioner who has permissions and who needs to care for a member needs to see a holistic view of the member. This includes all their medications, all their utilization, all their conditions and includes being able to view the whole care plan. A CM case may have a CM nurse and her care plan she created with member, a DM case may have a DM nurse and her care plan she created with the member, a UM case may have a UM nurse, who does not create a care plan but could benefit from seeing all the problems created and being worked on. They all are caring for the same member. For collaboration between the disciplines, increased communication between the disciplines and to reduce duplication of effort, team members of the member need to be able to view the whole care plan. Adjuvant team members may need to add to the care plan on a case, like a social worker or a dietician. They may not own the case but they contribute to the care plan. Whoever enters the problems, goals and interventions should be identified. There may be a reason to lock some problems, such as a behavioral health issue that laws protect confidentiality, this would require market research.Spring Cleaning (Deprecation and control frequency evaluations) Deprecation can be done creatively also because I know there are concerns on deprecating features and controls. They can fade gradually in the user interface by lowering them in the hierarchy. The supporting data collected from customers on what to deprecate would be the determining factor on what to get rid of. The product design should conform to the customer commonalities. A process should be in place as to what should be Pro Serve vs. making it into the product.NHP“It’s a beautiful product if you use it correctly.” – Martha BadgerI found that there are a lot of useless functions in the product. Either the users don’t know they exists or they are to complicated to figure out and buried in the hierarchy. Perhaps there has been one off requests for functionality in the product that have driven the current state of the UI. Design should be driven by the commonalities then built off of the commonality framework in modules catered to that client’s needs, goals and or process. Visual affordances are lacking or current ones are confusing. Users are expecting functionality they see in other UIs to be implemented into the product. Example would be when they do a search the data inputted into the search fields would pre-populate into the forms. To keep building on the existing framework is causing it to collapse.Wellpoint“The product is over engineered in places.” – UM Student“There are a lot of moving parts.” – UM Student“To many place to look for the same thing.” – CM StudentCase Lock 4.4 in CM get rid of it ASAPObservations made of this control were very interesting. Users would release at the end of the day because they forgot. Interruptions happen. The thing about the control it’s stopping other workflow because the case is locked. Users have to yell over the cube to release the cases, send emails and ask the supervisors to unlock them. Font Size Font size is a concern. Observing users body language. They lean forward and squint while denying they can see the screen just fine. Accessibility issues brought up by usability when checking the contrast with the contrast tool.CustomizationThe mere fact that in the workgroup session they started with a blank sheet of paper and threw out suggested cards to work with tells us they want the customize Care Plans. Blank template create your own. Our all customers using just guidelines from the library.Activity in a member when highlight should be tracking the time with that member automatically.The product’s UI design and training has altered normal human behaviorThe product fails to achieve the user’s mental model on different accounts. An example is how the tasks are to a case and not to the user. Many labels are confusing to the users. Pages sometimes are not clearly marked with an H1. Users don’t know how they navigated to a page. When they use other applications they are expecting the same behaviors in the product. Example if they do a search and enter in data that data should pre-populate into the fields. Another example is the Member Overview. It functions differently in the product. It floats with the icon in the top navigation but doesn’t in the left navigation. Facets is another example as users are use to double clicking in Facets and in CAE they can’t. Inconsistencies in the product made training confusing for users. Example was the Member Overview floating from the icon in top navigation and not floating in the left navigation. The training environment that the trainers use is riddled with bugs. The environment was slow and at times there was no performance. This became frustrating for students and instructors. CM users often after they reviewed something still forgot how to navigate to an area of high frequency such as care plan. One user said, “Oh stupid me”. NHP “We tell everyone that they are forbidden to use the back button in the product.” – Martha Badger, CM & Content ManagerBCBS of TNThe UI has caused a training style within organizations. “It takes time to explain the many paths to take to do the same thing. In the end it just confuses them.” – CM TrainerNHP“It’s floats! It scales!” (She didn’t know the Member Overview icon floated)– Laurie FarquharsonAdaption rate and culture that the product has createdNHP“It’s so easy to do something wrong in the product.” – Martha BadgerAdaption rate is slow for the product to be efficient at first. The culture that the product has created is a reflection of adaption rate. It will be interesting to see if other organizations took 12-18 months to implement the product and how they worked it into the existing process or adjusted their process with CAE in mind.Accessibility Reading font size small in areas.Technology“Ask meds first then issues later.” – BCBS of TN – Screener A fed by a pharmacy into CCA would be of great importance at the assessment level prior to starting an assessment with a member. Users have indicated that before they start a Risk Assessment it would be beneficial and a big time saver to know what kind of medications the member was on up front. This would also reduce errors.Policy & procedure online was created in how to use the system. They use this instead of help.Any assessment should have an add note feature next to the question to record information that the member gives outside of the question. Currently they write down notes to type into a progress note later.Progress note original usage is for what? They use it for everything. Barriers are entered via progress note with most users.Integration of widgets within CCA would be beneficial. (Calculator in cost savings) User was looking around for a calculator.To understand the workload of our users a comprehensive list of most frequent and important tasks needs to be identified. Then the list needs to be prioritized for the initial design work. Smaller enhancements to improve usability will be discovered and documented for design to enter in a queue.6. results from the interviews of supervisors & Cms BCBS of TNWe had round table discussions with supervisors and one on one Q&A with care managers for an hour with each line of business with BCBS of TN. We collected responses from both roles.A Typical Day with Our UsersCare Manager Supervisors: All open up multiple systems. 25 people telecommute in commercial. Commercial makes home visits. Complaints they get from their team are, working at home the system goes down after 30 minutes system. 1 week the whole system was down. Laptop users are only having these problems. They have letter printing issues and tracking issues. Some users are not reporting the issues in fear of having to come back to the office to work. Users have to send to the printer twice to print once. Most of the morning is spent with staff answering questions, giving directions, etc. They also spend the morning responding to emails. Medicare Supervisors FFS, PPO MAP and MAPD plans, all inpatient admits are referred to CM. Screeners are nurses. They look at diagnosis, claims, Facets UM notes, if readmission is it for same diagnosis? (We had discussion on HCC functionality; they were unaware of it and are not using it.)Disease Manager, Supervisor Open necessary programs including Care Advance and begin working tasks from my tasksCare Managers: Clinicians, Medicaid: Launch Facets, CAE, Outlook, Word, Referral Notes, MEDai risk drivers. ICD 9 Code. The ICD 9 is useless in CAE user states. They have to know the ICD-9 description to search, nobody knows that information. They need to be able to search heart attack not myocardial infarction. It does the same thing as Facets. So we Search in gene IX encoder Pro. Online users go to Encoder . All cases are in spreadsheets. Imaging (claims scanned image system), Imaging Process Design, IPD pulls any claim on a member. Address, phone number and call provider. Weekly 70 to 75% of users’ time is looking for phone numbers. They navigate to CrossRoads, Mr. Doc Man. Notes are made on many note pads. Six screeners are on the Medicaid team. Every week workflow changes for each user on the team. They look to see what they have to do for the day. Reviewing day’s tasks, assignments, faxes and emails to plan the day.Screeners, Medicaid: Clock in and open up the following systems they use every day. Facets, CareAdvance, HCS Provider Viewer, Notepad, and Soft Phones. Then they read any emails they have including the plan of action for the day from the supervisor. From there they work tasks, CTI outbound dialer, supply orders, reports on occasion, and any issues regarding letters with the nurses. They work the reports, set up cases for nurses. Drop call reports, inactive case report Facet bucket, create a task for nurse. They also direct assign a member to the nurse as well.Clinician Disease Manager, Medicaid: Open IH250, Facets, softphone, My Tasks – change filter to todayScreener, Medicare: They look at Facets bucket, research to find a member for CM then build a case in CAE. Check emails in Outlook, launch CCA, Facets. Builds the cases. Sometimes has to find a pharmacy that will take it. Out of Facets UM bucket, customer service sends CM. Another user deleted cookies, files & clearing history on internet explorer, then opening all systems needed to begin the work day thru xendesktop (care advance, outlook, facets, word, next gen CM, ETG database –access based, genesys, screener list – excel based, CM database – access and web based, Encoder Pro, Crossroads and FEP Direct.Case Manager: Turns on computer and all the programs used, then determines who they need to call and who needs to be presented on rounds.Clinician, Medicare: Launch apps, CAE starts work on lists, calling people. Get verbal consent for CM then they have 7 days to get assessment done.Clinicians, Commercial: CCA Login, launch Outlook, Facets, Excel Spreadsheet, Word. Checks Resources for approval or denied. Checks to see any message from Supervisor. Driven by workflow. Process heavy. Another clinician pulls up all her members, all active members in the past month. Has a list of members in work file. Looks at CM for new cases, new referrals, hospital stays, new DM. Reviewing what callbacks need to be made, setting priorities of the day. Reviewing and approving authorizations and contacting new members/hospitals etc.Transition of Care, RN: Opens up programs, open up spreadsheets,?checks my tasks in CareAdvance,?reviews member worksheet, checks hospital census once available, has daily worksheet available.Triage Nurses: Reviews emails and external work list/buckets (MrDocMan, Tasks in Care Advance for consults, and Outlook Fax GMM Folder) to see if any cases need to be triaged to appropriate area. This may include assignment, transition, or obtaining more information to process the case. Once the emails and the external work list have been completed, they start working the Facets SGMM_CMREF bucket/work list.Users Personal Work GoalsCare Manager Supervisors: To be as productive each day as possible. To ensure the department runs smoothly and the staff produces quality work.Medical Manager: Personal goals are to respond to read 100% of emails and answer telephone calls. To attend all meetings and allow time to complete my personal work and assignments.Disease Manager, Supervisor: Contact members within specified time frames as designated by program guidelines. Complete work in fashionable and timely manner.Care Managers: Clinicians, Medicaid: Serve the member/customer – provide best quality healthcare. Get the nurses all the cases they need for the day. Doing job well and competently, done right and to go home.Screeners, Medicaid: Keep tasks within a two day turnaround time, maintain four hours a day on CTI, complete 100% on phone and screen audits per quarter, keep brochures and supplies stocked, work any reports that supervisor requests, and handle any issues the nurses need assistance with daily. Get nurses “maxed out” 3 DM and 3 ESM cases per day. Literally it’s harder to do than you think because they have to go through many members before I find one appropriate for referral.Clinician Disease Manager, Medicaid: Open IH250, Facets, softphone, My Tasks – change filter to today. Urgent first then High with 7 days to get to.Screener, Medicare: Type A personality. Wants everything done right. Most driven on the Team. Get it done now. Task List. Driven and task oriented wants it done right now and right. Never has a late task. A screener is different than the day to day activities of a case manager. Personal work goal is production oriented and that is to be able to assign 25-30 cases/day, assign them to the most appropriate level of care we have to offer, and to ensure the receiver of the case knows why they are receiving the case.Case Manager: To increase case load to that of co-workers, To have all HRAs up to date and to continue getting and faster with the processes. Clinician, Medicare: Daily to meet member’s and providers needs quickly and efficiently and to be pro-active in solving problems before they start.Clinicians, Commercial: Basic, to keep caught up – pass audits- tight turnaround times. Leave here felling they did something that matters. Stay current on tasks for members and job requirement. Personal satisfaction that they have assisted member/providers to very best in providing and them receiving quality care-based on individual needs.Transition of Care, RN: Personal daily work goals are: to complete all tasks to the best of their ability for the day, review the to-dos for the next work day, assist co-workers, and treat everyone they come in contact with respect.Triage Nurses: Utilize functional and technical expertise by analyzing, entering, and routing member’s clinical information in an accurate and timely manner. What motivates Our UsersCare Manager Supervisors: One CMS feels her department has a lot to contribute to the success of the company and she needs to do her part. Personal satisfaction. Salary.Disease Manager, Supervisor Open necessary programs including Care Advance and begin working tasks from my tasks. Their members and work ethics. Medical Manager: Working with a great team and having opinions considered and appreciated.Care Managers: Clinicians, Medicaid: Putting their selves in position with the member. Getting the information, proper communication and education they need. Members have strong chronic conditions and are on a lot of medications. Personal work ethics and addiction to food, shelter, cats and grand baby.Screeners, Medicaid: Moving up in the company throughout the years learning different jobs and in the process being successful throughout the career at BlueCross. A drive to get cases assigned and doing it right. Team players and being a morale officer at work. Payday.Clinician Disease Manager, Medicaid: Having a goal for the day and completing the goal.Screener, Medicare: To make a difference. Accomplish something.Case Manager: Personal satisfaction and knowing they have helped a member or provider. The love of their co-workers and the work environment. They really enjoy doing this job and feel like they are making a difference in the lives of members.Case Manager Screener: Personal satisfaction that they have given their best effort to BCBS. Clinicians, Commercial: A sense of accomplishment. Important to impact members and get them what they need.Transition of Care, RN: To make a difference in a member’s life.Triage Nurses: Work ethic and sense of pride in what they do. How Our Users are Measured on the JobCare Manager Supervisors: CMS requires an HRA on new members (this is done by a 3rd party, beneficiary fills out after signing up for plan). Monthly audits for accuracy. By the number of members assigned successfully each day. Commercial it’s by case load and turnaround times. Audits. Some cases are open for two years. 50 to 70 members/ per user. (Audit criteria they are sending via email.) CMS performance is measured on the staff’s productivity and quality. 40 CM caseload, they have turn-around time audits, some have members 2 years some 30 days. Average is 50-70 member caseload. Some 100, is dependent on member acuity.Medicaid wants to see how they handle barriers to care, these are captured in a concept in the assessment. So Care Plan needs to address areas identified on Care Plan as problems. They want to see their HEDIS scores go up.Disease Manager, Supervisor: Job performance is measured by Quarterly audits and weekly productivity sheet. Member contacts will vary daily due to differing member needs and the amount of enrollments completed. Medical Manager: Annual performance review, biweekly 1:1 calls with the director, feedback from staff and co-workers. Care Managers: Clinicians, Medicaid: Monthly quality and quarterly audits. Measured on goals, consents, number of open cases, cases built correctly, case phase, assigned to the right nurse, correct letters (errors). Phone audits. Checklist of tasks, and what is said on phone calls. Entering chronic conditions. Auditor has a check list. They pull up random cases and check them against these lines. Day to day it has to do with the numbers and acuity of cases, and all the Access TN people have to enroll in the CM program. Quality, compliance, workflow check. Documentation, required accreditations. Touching people and decreasing cost. State doesn’t know how to do it. I’m not measured by cost savings.Screeners, Medicaid: Measured by tasks, audit scores, phone calls, enrollments, projects completed, and attendance. To stay within a two day turnaround on tasks, complete around twenty calls in a four hour timeframe on CTI, keep brochures and supplies stocked, and complete any other projects a supervisor assigns in a timely matter. Enrollments can vary so much depending on whether or not they reach the member on that day. You could have anywhere from zero to six enrollments in a day. They also check to see if users maxed the nurses out every day.Disease Manager, Medicaid: Audits – daily summary sheet - # calls/attempts.Screener & Clinician, Medicare: Monthly audits – everything on checklist done, medication, medication list. Put into all progress list. Checkbox workflow. Care Plan update every month, calls, safety, barriers, progress note, address. Progress, Diagnosis concerns, barriers, outcome, Q&A to members. They care for 80–90 yr. old members. Screener has audits, nurse has audits. Documenting barriers to care in progress notes, things like that.Case Manager: Job performance measured in audit scores and feedback from my supervisor. Numerous member contacts-average patient load. Setting goals with the annual evaluation and must meet them. Also cases are randomly audited. They are free to ask for direction and feedback from their boss. The case load and members that are assigned to them are determined by who has the fewest, who’s up next, etc. Case Manager Screener: Audit tools. Audit scores are given monthly, they are also measured every day how many cases they have assigned. Clinicians, Commercial: Monthly audits. Supervisor audits. System training (3 audits). Quality audit, system and training, and supervisor audit. Audits. policy, procedures, turnaround times on care plans. Care plans in place 7 days from time talk to member to consent.Triage Nurses: 90% on quarterly audits and if telecommuter 97% on quarterly audits. Attend all mandatory in-services. To have a general idea since they touch so many areas-Catastrophic Case Management/PDN-East and West, TOC-East and West, BH consults-East and West. They get feedback from different areas on routine basis since things at VSHP change so rapidly. Our Users View of Our ProductCare Manager Supervisors: Good product but ongoing issues. Navigation confusing. It has serious problems at times. It has room for improvement but overall it’s a good program which meets their needs. It can be painful. Is it internal or CAE they wonder? I like it. Some feel like they have an iron blanket on them. Somewhat user friendly but some area could be improved . Performance issues. Script scanner they took off. We use word and excel to aid in tasks. It is improvement over facets CM. CAE has quirky things that happen that cannot be explained: 278 user error when trying to put in migraine diagnosis, could do it yesterday but cant anymore, another user can do it on member. In the morning has to print a letter 2x to warm it up… While printing or after printing went to go to another member and whole computer frozeCare Managers: Clinicians, Medicaid: Reminds a user of being in a doctor’s office where the nurse is taking notes. – great tool. Same view – not much has changed. (Locking of cases is a pain.) Performance an issue. CCA fills a very important need in the insurance industry. Users like it. User friendly then it was. One user likes the many ways to get to something. Difficult to train however. Care Advance is sufficient for documentation.Screeners, Medicaid: It is easy to learn and it makes it easy to complete daily tasks when working properly. It’s a good system, user friendly, not sure if it is the product or BCBS but it is too slow. The address book should auto populate, they have to add a “doctor” and sometimes it is the same as in the address book grayed out but they can just copy and add that one, they have to add each piece of information by hand. The state is the system of authority and does not have accurate or up to date info. Diesease Manager, Medicaid: Don’t like it – not the layout but it’s slow, hangs – she works fast. Case is challenging – creating a Care Plan - time consumingScreener & Clinician, Medicare: Delays. Training, it was difficult to learn. 2 day training ? days for 4 days a week. Case Manager: Has a lot of system glitches. Freezes a lot. At times can’t get it to take conditions etc. Slow at times. Do not care for the poc and having to go back in and change goals from short term goal to long term goal and vice versa. It has a lot of glitches and the interaction between it and other programs leaves a lot to be desired.Case Manager Screener: Too generic, unable to personalize to members specific needs. Not consistent with speed, too much down time. Time consuming. Have to constantly look back to make sure it actually saved what I have assigned correctly.Clinicians, Commercial: Easier to learn vs. Facets – progress notes, screener notes MEDai. At a glance. History. Cumbersome. It’s measurable. Transition of Care, RN: Its good it has various ways to get into areas of the program. It offers resources within the program to help do the job. It is user friendly. It does run slow at times.Triage Nurses: One user’s view is mixed on this product. She likes that the assessments are built into system and you can view the assignments and their history quickly. The Case Overview feature is a quick way for Triage to look at a case and see why it was referred or closed. The “More Information” button is another very good tool that allows information to be reviewed quickly. What Our Users Like About Our ProductCare Manager Supervisors: When working properly it’s quick and efficient. User friendly in places. It is designed as a case management application. I believe everything case manager’s need is available to them in Care Advance. Ease of navigation, training is a 2 week program. Screeners, Disease, Clinician, Triage Nurse, Case & Care Managers: They can see and read everything. History is excellent. Easy to learn and use for some. The navigation throughout the product is very simple. Easy to read, easy and get information. All info they need is in Case Overview and Member Overview. Copy and paste into Facets-Progress Notes. Screener notes MEDai. Like checkmarks, tasks, to be able to focus by using tasks. Covers some of the medical needs of these members. Templates the way it’s set up from Facets. Provides good info when working correctly. The templates and letters are easy to use. Tasking is an excellent tool and conditions as well, but they are only as good as the user (would be nice to pull significant conditions from claims billed automatically, such as diabetes, CHF, HTN…not necessarily routine office visits for colds, flu, ect.).What They Don’t Like About Our Product – (Most of all performance.)Care Manager Supervisors: Case lock feature. Need to simplify UI and filters, too much information and too many ways to do stuff. Not holding information already entered. Access to Care Plan, care plans collapse while working on them. Letters tree defaults to open, short term goals and long term goals being set by the system based on time since creation of goal. Good product but ongoing issues. Navigation confusing. Member in focus has to be bigger. (I ran the idea of having the member in the center top of the page which she liked. Covers only some of the medical needs of these members. One user couldn’t understand why we cannot make the 3 programs that they use the most talk to each other. There is too much duplication. Also, the page with the library for Care Plans should not pop up each time. It should be there as a reference tool, but you should be able to go straight to the care plan. Down time, speed, in the case properties screen having a description field and a notes field (they only need one or the other – not both) and the limit of characters in the description field, when closing cases having a note field, not necessary and if anything is entered their causes Facets not to reflect the case closed, this user has never used that field but for some reason some of my coworkers fill the need.Additional:Queues- only take 100, its all or nothing, if you say 100 all queues will give back 100.Can’t flag h-m-low acuity, they want to hit the ones they can impact the most. Training takes a long time there are too many ways to do one thing.They want floating windows like HRA and Care Plan they have to keep getting out of what they are working on to go somewhere else to get information or work. Can’t multitask in the product.Can’t change dates on milestones. They need to capture date opened this date changed or updated. They can date but time? Unusual to need a time. It’s recorded everywhere.Updating a Care Plan is too time consuming, when you finish a milestone and save it does not take you back where you were. It collapses the Care Plan.Letters no filters.Care Plans (gds)-no filters, have to scroll and choose one at a time.Hard to delete triage reason without going through many screens to assign it to someone first.Progress note filter, always reverts back to original sort and it is not descending.No alphabetical order in drop downs.Can’t cancel an assessment.Condition list no way to sort by alpha.Adding conditions painful.Medication list- no way to sort drug by alpha.The med profile is not workable-have to make manual note.Should have some different contacts listed in address book. Don’t really like functional aspects of poc. Having to delete goals not wanted, should had to check ones you do want instead.Screeners, Disease, Clinician, Triage Nurse, Case & Care Managers: Performance is slow. Physician practice is not there. Recent doctor, address book, so they have to go back to Facets. They toggle all day long. DM workflow I have to copy and paste from Facets the recent information into a progress note. Another thing disliked about the product is the way it freezes up and just spins. Users would like to see a feature that will let you filter the member phone logs or provider contact logs. If there is a filter that will perform this task, they are not familiar with it. Triage reviews member phone and provider contact logs to help determine how to Triage some of the cases reviewed but in this process, they have to go through each page to find this information. That can be time consuming when the member has had several cases in past or if a case has been opened for quite some time-example PDN. Care Plans. Build own. Takes to much time that they don’t have. Canned care plans would save so much time. One user said they can never find what they need. Advance options, not sure how to use. Contact detail phone ext not enough room. Its cumbersome, takes time, things are scattered all over. They are double documenting and double documents in the system. Example goals in Care Plan then they have to document in progress notes so the auditors can see it better. To many clicks required and often freezes up. Would be great to have drop down boxes that they could see. They don’t like that they have to tab through the all the entries after opening one to view it and when they close it they have to start over again. Ideally they would want to go to the end of all the entries instead of tabbing through the entire documentation trail. It would be easier for history gathering if the medication, diagnosis info etc under the member information tab was included in the HRA. The Plan of Care process as far as changing the dates is very cumbersome and takes a very long time to complete. Additional:Medications! 3 pages of meds. Then I have to go back to the beginning of the list and it scrambles the drugs and members to! It just takes forever.Can’t do 2 things at once.Medications, they may have 25 meds, when you touch a medication and save it does not go back to where you were in list and the list may be scrambled from the original list you have, so they have to open every med and now they don’t know which ones they opened and which they did not. Diagnosis codes: They can’t search terms like breast cancer, it brings up nothing. So they go to ENCODER to find the real name and enter that like neoplasm of breast.The short and long term goals won’t stay, after 61 days they are all long term. So they have to write in the description if they are short or long term at least gives them option if it is a short or long term goal every 30 days when addressed. They change.User friendly when the fixes were made.Lots of clicks and back and forthHow Our Users Get Work AssignmentsCare Manager Supervisors: The Care Managers get their cases from the screeners who check for eligibility, benefits and they set up the case. The screeners have no direct contact with the member so get the referrals from a UM nurses. Care Managers are notified via a task. If they need to have someone cover their case while they are out, the supervisor can manage the workload and assign to another CM. Others get them through referrals from facets (a manual bucket that is worked) they look in bucket, do some research then manually load a case in CAE and Task. Campaigns send lists of members to a queue.Different lines of business and users work differently, users on a time restraint. They need to have easy access to everything and to see data. Some may look at patient list, some at tasks, some cases, no matter which one they look at they need to be able to sort easily. They have 15-30 days to get in 3 attempts and open case. So they need to know where they are in process by looking at these lists. We don’t understand the fancy filters. Case load 122 for Medicare 60-70 Behavioral Health.My work assignments they are not using at all. Get case assigned. They print this out. Problems, Reason code freezes, They can’t change the reason code. Auto Triage has speed issues.Medicaid CMS get their work from state reports. At a high level: how many did you touch, what was the engagement rate, productivity, stratification (workload). There is a hole in CAE cannot get reporting needs met or financials- on how they saved money.Medicare is pursuing to be member centric – they need the ability to work on more than one member at a time. There are not many working on the same cases.Non Supervisory Roles: Screeners: They assign cases to the case managers. They get list of potential members from an internal database, screen them for case management needs, build the case and assign to a CM. Another Screener: Facets, reports from within the company, triage in care advance, and tasks in CCA for 60 day rescreens. There are times that they have to assign a case or refer to an outside vendor while another case is open. If they have to build another case while one is open, they have to start by building the case from case properties screen, set the case they just built as default, then make the appropriate assignment.Clinician Disease Manager, Medicaid: My Tasks. Shares case with a screener role. A work habit is she filters back to the beginning of the year to see all tasks. In Disease Management there is usually a non clinical employee on the case along with a nurse. The nurse is primary on the case.Disease Manager Specialist: From DM Screeners and workflow tasks. Only her working her assignments. However if for some reason she is out sick her supervisor can set up working sharing. They help each other and may just email coworker the member numbers to assist with the work.Screener, Medicaid: CTI Dialer, Letter Report, Incoming Line, and Supervisor.Clinician, Medicaid: Report and email. CAE My tasks icon in the left navigation. The report may have two people working with the case.Case Manager Medicaid: My Work Assignments tab. The only one working with the case. She loves how they are bolded. Not touched. Screener sends same task which is same task. Case Manager: Supervisor e-mails them to let me know when they have one assigned. Only one assigned to the case.Another Case Manager: Tasked to her via triage unit for new member assigned, otherwise, the plan of care or workflow tasks her and she make tasks for her self – Likes the self tasking ability.Clinician & Screener, Medicare: Task List. Social Worker – Email is sent to them to unlock the case many of us don’t work on the same case at the same time. Dual Cases.Clinicians, Commercial: My Task list from the screener. Is the only one working on the case unless she is away on vacation. My work Assignment – only to see brand new members.Transition of Care, RN: My Tasks. From triage. BHO can also be working with the member.Triage Nurses: Triage assigns the case to the Case Managers and TOC. What Our Users Think of the Online HelpThe majority of users asked say it’s useless. Cheat sheets are made up for users. In training they don’t refer to it.How Our Users Search MostlySome reported gliches with search were noted from the user such as with certain names the users have to hit search twice.Case#Subscriber ID#Member ID# DOBMember Last Name, First three characters or whole First Name ( But it takes to long )Group#SS#My Tasks filterOCC nameNHP ID#The Back Button(s)“We tell everyone that they are forbidden to use the back button in the product.” – NHP, Martha Badger, CM & Content ManagerOccasionally they will use the CA back button. Some use the back button only when Care Advance locks up and they need to move away from the screen they are in. Not a normal way to do things they said. They are trained to navigate without using the CCA back. The CCA back doesn’t take them always back one step. This is why this has forced them to train using neither of the two.Some were told years ago not to ever use the browser back button. In observation some users use the right click browser back function. Also observed, on many screens there was no browser bar at the top at all so this eliminated the browser button being clicked but not the right click functionality for the browsers back.CAE MailAll users interviewed said they don’t use the mail in CAE on the homepage.CAE Today SectionAll users interviewed said they don’t look at the message in the today section on the homepage. In fact many said the message was there from the beginning of the install. So messages have been there longer than 6 months. This section holds no value to our users.CAE StatisticsAll users interviewed said they don’t look or use the statistics section on the home page. This section also holds no value to our users.Date in the Top NavigationMany users did not know the date was up there. This holds no value to them as well. Many are in their calendars in outlook before they get to CCA. Greetings UserThey could careless that they are greeted on the homepage or anywhere else in the product. Date of last login and time they do not look at either next to the greeting.Alerts in the Top NavigationBCBS of TN didn’t have this feature turned on. NHP ignores it.Member in FocusUsers got use to after a while. When they first started off some kept forgetting to look up in the left corner to see which member was in focus. The would enter in notes for the wrong member. The biggest issue is the size. It’s hard to see for many users.Case LockThis features is cumbersome to users. They don’t forget to release cases until the end of the day or until someone sends them an email or comes to their desk. This feature no one uses that we observed. The workflow has conformed to a worked around for this problem. I question the feature and how many of our customers use it. Nurses do all the time (95%) – have to have supervisor unlock the case 3 or more times a week because nurses don’t unlockIconsWhat we found out was that the icons do not help aid the meaning of the controls. The label is sufficient. The icons add un wanted visual clutter. Users often would what the icon is or what it means. Another concern is just having the icon with no label. The alt tag is the label in some situations such as the quick links at the top of the left navigation. However many users have the alt tag turned off in the browser. This is dangerous.AidsAll the users interviewed and observed had aids for helping them during task completion. They vary from, post-its, binders, intranets, work documents to diagrams. Discovering that the help is not used at all and if ever used did not provide the user with the answers they needed. Creating a CM Care Plan Building the CCA Care Plan with the memberScreeners start to build a care plan when a case needs to be opened on the member. No consent is needed. So many care managers start on the phone with the care plan already constructed.Consent is needed from the members in all line of businesses except for Medicare and parts of Medicaid. With Medicare they just need to be a willing participant. DM for Medicaid is mandatory – don’t need consent also. The member is not on the phone in most cases when in CCA constructing the care plan because often times they only have the members on the phone for a short period of time. The user interface in CCA also takes time to navigate through so they don’t want to waste the member’s time. They tell the member what they want to do and get consent verbal and written.Care Plan & Policy Drivers They build care plans based on the issues/conditions/gaps identified during the assessment which is completed with the member. Regulations, URAC, NCQA, 36 HEDIS, Medicare. Care Plan ability to report off all info for the line of business. QIP patient safety 97% bench mark 100%. Condition List. They have one screener that is a nurse. They create the care plan and address ALL pertinent needs, so there is a strong correlation.Quality Assurance check on Care Plans Question asked: When you are doing a QA check on your Care Plans, what are you looking for? Responses: We look to make sure that all gaps, issues, conditions are address in the care plan. Especially safety issues. We have an audit tool, look at that tool and you will know exactly what we look for. Individualized, specific and comprehensive. That the plan of care addresses all areas of need identified in the HRA/progress note. If we follow URAC guidelines.Disease Manager Specialist: To assure that my care plan address’ members needs and deficits Screeners, Medicaid: Audit tools – case properties/description “update case phase.” For the Disease Management Associates we mainly use the CTI DMA Workflow, CaringStart Workflow, or the Adult Direct Assignment Workflow depending on the case. The Intro Letter and Brochures need to be sent out to each member with an open case.Care Manager, Medicaid: Compliance with the audit tool. Nurse workflow. Gaps in care. Quality. Improve products, living will. Individualize – no boilerplate. Disease Manager, Medicaid: Checks everything – timing, late on tasks/timeliness/Documentation up to dateTriage Nurse: I would think they look for individualized Care Plans specific to that member. Things have changed since I was a Case Manager and TOC mercial, Clinician: Met members needs. LTG and STG. They put in workflow. They look to see if I added the gdls I am supposed to. Read all progress notes – look and see if user has address the issues – filters to see her entries then looks at the care plan. Short and long term goals. Do the problems I ID in assessment reflect on Care Plan. I have to have safety on the Care Plan.Case Manager, Commercial: Stg/ltg and all needs being met or addressed. Screener & Clinician, Medicare: Dates span, meeting goals, right diagnosis, addressing issues and they look into progress notes. Medication reconciliation on every call, I have to open every medication and close it to get a new progress note to prove it. Date spans correct, goals appropriate for diagnosis, make sure we are addressing goals, have to open every goal and sometimes interventions to chart on, then I also put it in progress notes.Medicare is looking for UM part, QA department. Screening as well. Claims history. UM note review. Readmissions.Care Plan > Problems (Conditions )> Goals > Barriers, Interventions & OutcomesQuestion asked: Do you agree with this association? A Care Plan is made up of Problems, those problems have Goals, and those Goals can have Barriers, Interventions and Outcomes?“I did not know about barrier milestones.” – BCBS of TN – Care ManagerResponses: All agreed but we learned that most users document the barriers in a progress notes or they don’t document them at all because they say they don’t know where to do that in CCA. Many also said that there are gaps in care plans. Changing all dates on case properties screen w/tabs. Assessment, Problems. Condition – Resources/how to help/what we do – Communication/outreach – Solutions. Users should have the ability to update the goal not the intervention. Here is how one user sees it:Condition of Member.Resources (How do we help them).Out Reach (Communication).Solution.Then there was this statement, “Case around care plan.” So again what we are hearing is that the care plan should not be attached to a case but the member.Interventions are redundant. Update Milestone and include in progress note. Just goal not intervention. Sometimes 40 of those things. Every 30 calls. Yes, although the wording can be confusing at times. Milestone is a problem. Mostly Goals MUST have interventions and outcomes in order for it to be a Care plan.“The whole wording within Care Plans goes straight to hell. Hard to teach the language. The same thing is named three different things!” – BCBS of TN – Care Manager, MedicaidThen we also discovered some labeling issues. The word Problem sounded to negative. Diabetes isn’t a problem it’s a condition It should be labeled Condition(s). The word milestone means the problem to some users. A labeling exercise would be beneficial for Care Plans.Care Plan CreationQuestion: How do you create the care plan?Responses: Library Guidelines. Cases, Edit, Add Milestones, BCBST Workflow, choose Appropriate Guideline, and then check off the needed items.Workflow import suggested guidelines. Blow past the stoplight page.Some go to the Care Plan tab and pick the guidelines one by oneQuestion: Do you use recommended guidelines? Responses: Workflows set in place for our Department. I skip the suggested guideline page, too cumbersome. Blank template. Goal, Intervention. It would be great if we could drag and drop them over. Unchecking it time consuming.Question: Do you add guidelines from the “Add milestone” page?Responses: Yes that is how we Import our Care Plans. Very complicated process. Yes but it is painful. STG & LTG workaround in the subject. They change but the date drives this which is not good. It always goes back.Question: Do you adjust the due dates? Responses: Not usually unless we are working Manual Call Outs.Question: How granular would you like the dates?Responses: The care plan dates and the short vs. long term goals need to be fully set by the CM. A short term goal that was created more than 30 days earlier is not necessarily a long term goal. It may be a short term goal that has not been met. Have to – Audit driven – should be in Care Plan. They don’t really go through progress notes in detail. Don’t know what they mean. Due dates are necessary, its just a lengthy process. I do not want granular dates. This makes things very time consuming. Care plans have to have set dates to achieve goalsQuestion: Are due dates on all the care plan items useful? Responses: Yes, essential but most case managers send themselves a manual task for follow up and address the care plan at that time. They do not rely on the care plans automatic. They adjust the dates. Useful for not getting into trouble, remind me task. All goals have to be measurable. They update every 30 days so this triggers me to look at them. They are very useful to the users. Constantly resets – as many in bulk as possible – Intervention dates DO differ from goal dates. It becomes very repetitious to have to change dates on all the items so it’s consuming the users time. Bulking them is one solution. Goals need dates also.Question: How many problems do you typically address in a care plan?Responses: It varies widely depending on the needs of the patient. I generally they see anywhere from 1 – 6. It snowballs after duration. NOTE: Interesting side note on the working habit that the system has created. One user said that during Assessment loading time – writes out everything - the system froze while on the phone with a member and lost everything. So from that experience she always takes paper notes. She has 330 DM cases with a notebook of all those members.Task & InterventionQuestion: How would you describe the difference between a task and an intervention? How do you use tasks when working with a care plan? Responses Tasks: Users see tasks as something they have to do (action) and serves as a reminder to perform their job. A task is something that either the CM or the member needs to complete while an intervention is something a CM would do. Most send themselves a manual task for their 30 day follow up and do not use the automatic care plan tasks. Disease Management Associates only work tasks from the Care Plan or tasks that have been sent to us by the nurses. We send the Intro Letter and Brochure to the member, check to make sure a case is loaded in Facets, Inform the Member of the Care Plan, and Send a task to the Screener to assign to a nurse using the Care Plan. The task is not associated to Care Plan.Responses Intervention: Intervention is what they need to do (action). Intervention could be verbal to member – Care Plan is member specific. Focused only on member by member then to task list. I know the intervention task is for the Care Plan so I know what date it is due.Intervention is how to or what. An intervention may be what that task is and how it is generated. Intervention is member related. A intervention is something you want to have member utilize in order to see changes. An intervention is something I do to help the member to improve their quality of life. Interventions are things that I will educate a member on in order for them to achieve the desired outcome and eventually the goal. an intervention is like I am educating them or I am calling a doctor.Editing Care Management Care PlanTask & InterventionQuestion: Do you make changes to a Care Plan once it is saved? Responses: Yes. A care plan is a living document. Case Managers should be revising the care plan as members make progress. It is changed on a monthly basis usually, adapted and updated throughout the life of the case. Screener role says not usually unless he is working a Manual Call Out task where he is trying to Inform the Member of the Care Plan. Some update the Care Plan milestones on every call. Constantly adding more or adjusting dates. Only to mark goals complete, or add new ones are the only changes some make. Also if it’s the wrong member or not a real problem so they take it out. Other changes are they go back and approve or mark as met/unmet while poc in process and add new goals as needed. Question: Do you manually select interventions and outcomes and add them? Responses Tasks: No canned only. Barriers mostly are recorded in progress notes. Some do occasionally create manually. Manually deselects them……not fond of functional aspects in POC. Some do select interventions and outcomes, but again most haven’t added any barriers yet. Some use what is available in the system and edit out what they don’t need before saving. Barriers are reflected in the care plans they choose often. Of course those are limited and don’t cover every scenario.Question: Do you ever add barriers to the Care Plan?Responses Tasks: Supervisors also say they don’t believe that their Care Managers are using the barriers. If it is reportable It would be useful. Barriers are not widely used on many teams within NHP & BCBS of TN. Some also add member barriers as guidelines. If they need to – Barrier transportation, it’s a guideline. Many users didn’t know they could add them. Another users stated, “I do not like to add barriers to my care plans as this implies that it is something that is stopping the member. I believe that everything is obtainable.”Question: Any other changes? Responses Tasks: Adding additional guidelines, problems, interventions, outcomes, marking goals as met, editing the due dates.Question: What would you like to see improved in the process for updating Care Plans?Responses Tasks: Easier access to the Care Plan (a shortcut icon would be great). If the problems/goals did not collapse after every edit of the Care Plan that would save the Care Managers a great deal of time. They currently collapse while they are working in them and they would like to see that changed. Pick a group of them more than one at a time. Many like canned care plans. More choices – uses same one – case specific. Time consuming – change dates. Contact unable to contact. We would love a attempted to contact button. Or a button if 3 attempts are made. Then a reminder is automatically generated in a few days. Too time consuming too many clicks, too many notes for attempt to contact. Import more than 1 guideline at a time, problems do not collapse while updating. Expanding collapse problems with every edit lots of scrolling. For goals to remain as you make them-either stg/ltg and not change on their own…this waste time to go back in manually and change them. Keep the add milestones from popping up each time you go to the care plan. A drop down box to choose STG or LTG without those choices changing automatically when the dates are changed. Quicker ability to import more than one care plan at a time. Question: Are there any restrictions when removing things from Care Plans once they’re created? Example would be of mandatory goals or interventions.Responses Tasks: Not at this time but it is being discussed. It’s hard to remove once it’s on the Care Plan. Some think it counts against them in the audits if they delete goals.Question: Is it acceptable or common to remove Problems, Goals, Interventions, etc. If so do those decisions need to be justified or documented?Responses Tasks: They do not remove but they can mark as unmet or not applicable. Some can’t remove now. If removed a reason code – CMS approval comes up. Barriers should be put in place anywhere. Yes it is acceptable and common to remove Problems, Goals and Interventions. No restrictions. If picked met or not met. They should only be importing the problems/goals etc that are needed. Some users just mark as met/not met and indicate reason-that is what a poc is for to keep updated with changes, additions etc. Justification is that each plan of care needs to be individualized to each member based on their identified areas of need so they more flexible the better it fits the member’s situation.Closing RemarksFrom the collective research done from these three customers we learned some important key take always to enhance our product. Learn ability of the product can be improved by reducing visual clutter, having consistency with styles and functionality and by conforming the product to the users mental model. This would also reduce training costs in the long run. Workflow enhancements such as allowing the user to work on more than one member at time would increase productivity. Designing the screens to take every pixel into account. There are a lot of wasted pixels that could be put to use displaying more of the content the users have to get at. The liquid layout is a solution along with other methods as moving the left navigation to the top. Using right click menus would also increase real-estate for certain controls that remain in the content area put are of no use to the users or to the current user at that point in time of the task..Eliminating controls that are not used by users. Coming up with a process that deprecates features for good or lowers those controls in the UI hierarchy. The frequency test would be helpful data to collect to support such a move.Asking the users what types of changes, additions, or deletions they’d like to see to the existing technology or work process is great feedback. However we need to find the common ground of all of our customers. Express that we want to make their jobs easier and will establish a ongoing working relationship to improve the product and their experience. Friday Workgroup session - notesASSIGNMENTSSplit the big group up into 4 mixed groups:In this exercise, document how you would go about assigning work so these members get to the most appropriate case manager. Indicate the steps you would take, and the information and resources you need to get the job done.#1: A monthly report that lists members who are high risk has been produced and needs to be reviewed for possible assignments. This month’s list has 1000 members. NOTES: They want to see FaceBook and Twitter Integration. Real-time feeds.#2: Inpatient admission >5 days report: John Stroke, a 49 year old male, married CM Referral info: History of CAD and HTN Admitted from ER 6 days ago, with chest pain that started at work Heart attack in progress.History of bipolar disorder Arteriogram showed 3 vessel occlusion CABG performed day of admission Complicated by a stroke 2 days post-op Currently on a medical-surgical floor NOTES: They want the address book auto stamp.#3: Member with a risk score of 9: Jane Fall, 87 year old retired school teacher, widowCM Referral info History of HTN, CAD, Type 2 diabetes, COPD-bronchitis, Osteoarthritis, Osteoporosis, and s/p total knee replacements. 3 ER visits the last 3 months for falling in her homeNOTES: Auto referrals. Build cases automatically. Tagging the skills of CMs. What strats. CMS enters skill or skills entered by CM user by a questionnaire. After entry then it is synced to the right Member/Case. Example: Spanish speaking member is tagged on intake. Then it is synced with skills tagged. IH250 downloads automatically. Auto brochure triggered from results of the HRA.#4: New member transitioning from previous plan’s CM: Manuel Lung, 14 year old male CM Referral infoSevere cerebral palsyOn a ventilator at homeLanguage barrier problemsParents having problems understanding the benefit plan May have to change providers Fear losing the support they currently have NOTES: Knows specialty. Based on diagnosis system knows which case is more important. Different colors – referral sources. Different colors Hospital.#5: Referral to CM upon discharge from mental health floor: Sally Head, 63 year old femaleCM Referral info 25 year history of schizophrenia, anxiety disorder and depressionCame to ER by ambulance, presented with auditory hallucinations Medical history includes CAD, Asthma and Parkinson’s disease CREATING A CARE PLANQUOTE: “I have my Blue Sky Now.” – Amber Casteel, MedicaidSplit the big group up into 4 different groups:1. Commercial folks2. Medicare folks3. Medicaid folks4. Mental health folksStratificationScenario: A monthly report that lists members who are high risk has been produced and needs to be reviewed for possible assignments. This month’s list has 1000 members. In this exercise we are going to create a Care Plan the way you think it should be mercial Scenario: Report for inpatient admission over 5 days has revealed the following member may need care management. John Stroke, a 49 year old male, works full time has POS plan with 1mil lifetime limit. John has history of CAD and high blood pressure. 6 days ago, developed chest pain at work, went to ER, found to be heart attack in progress. Angio revealed 3 vessel disease with 3 vessel occlusion. CABG was performed same day. Post op day 2 had stroke with deficits. He is currently on a medical-surgical floor. Has right sided deficit and some confusion and aphasia. Is married but marriage is strained, according to wife, and she does not know if she can care for him, she works and he is bipolar and difficult to manage. There may be financial difficulties. In this exercise we are going to create a Care Plan the way you think it should be created.MedicareScenario: The HCC Risk management report has come out and there is a member with a risk score of 9 who may need care management. 87 year old Jane Fall has a Medicare advantage plan with part D coverage with an OOP max of $2400. Her history reveals High blood pressure, CAD, Type 2 diabetes, COPD-bronchitis, Osteoarthritis, Osteoporosis, and s/p total knee replacements. Utilization records show 3 er visits the last 3 months for falling in her home. Jane lives alone in her home of 50 years. Her husband died many years ago and her adult children live in other states. Her income is limited and she may not be taking her medications correctly. Her adult children are very worried and want to put her in a nursing home and state that their mother is depressed and not herself anymore. Jane absolutely refuses to live in one of those homes and insists she is just fine, claiming “I just get dizzy” sometimes. In this exercise we are going to create a Care Plan the way you think it should be created.MedicaidScenario: The report the state sends monthly to notify the plan of new members has a member named Manuel that may need care management. He is 14 year old child on a ventilator at home. He is disabled with the managed Medicaid policy. He has severe cerebral palsy. There was a note from the state the family has language barrier problems and has problems with understanding the managed Medicaid. The state’s Medicaid program recently went to all managed Medicaid. Anyone with Medicaid had to choose a managed plan. They may be worried they have to change providers and lose the support they have sending him to school with a nurse.In this exercise we are going to create a Care Plan the way you think it should be created.Behavioral HealthScenario: A referral was made to CM after a hospital called to pre-cert an admission to the mental health floor. Sally Head is 63 years old, came to ER by ambulance, presented with auditory hallucinations. Sally had been calling 911 every 5 minutes for several hours prior to admission stating that the aliens were telling her they were going to bomb the earth any minute and something needed to be done. Has 25 year history of schizophrenia, anxiety disorder and depression. Medical history includes CAD, Asthma and Parkinson’s disease. In this exercise we are going to create a Care Plan the way you think it should be created.Build your own dashboardIn this exercise I want to design your home page with you. It would be more like a dashboard of your CM world. After you login this is the first screen you will see. So this could be a bigger picture of how you get your work. So I’m asking you how you would like to get your work in an ideal user interface.Value Captures – Reported IT problemsProblems identified by UM and CM staff (3/22/10)Problems were identified through observations of the work of each of the workers in the pathway and through a 2 week compilation of problems identified by staff during the course of their work: I. PRECERTIFICATION ASSISTANT: 2 Precertification assistants help to identify problems in the course of work for 10 work days. In a total of 18 shifts, they reported 205 total problems (average 11 per shift). Problem Descriptions that may possibly benefit from IT involvement in solving:When Precertification assistant takes demographics for a prospective UM or UM logging: she must enter Code 780 (general diagnosis) in Facets as diagnosis code. (This must be done every time). This creates rework:If provider has clinical information for the nurse, the person is transferred to the UM nurse. UM nurse has to change it to the correct diagnosis. (This is done every time)If the provider does not have the clinical information to give to the UM nurse at the time, the Prospective UM goes into the LOI queue and the following day, the Appeals nurse has to review each case and either “obsolete” them, remove from the queue because clinical is in, or send the provider a denial letter for Lack of Information. ( The volume is: approximately 224- 284 per week)Copy and paste was the most frequently identified problem by staff- though they do not necessarily see it as a problem- they see it as the best way to do their work in the current condition.System slow and Facets Clocking Clocking reported as a problem on 4 out of 10 days and on March 5th Facets down for 45 minutes.II. UM Nurse: 2 UM Nurses help to identify problems in the course of work for 9 work days. In a total of 14 shifts, they reported 2165 total problems (average 142 per shift). Problem Descriptions that may possibly benefit from IT involvement in solving:Case Management issues: (identified: 28)Can see that status is “open” but cannot tell if in process of assessing or accepted.Unable to find name and number of Case Manager assigned to the case.Specific details regarding system application issues:PSI: Not able to navigate through Facets while in Careguide (mentioned by both nurses)Checking procedure codes in Medical policy outside of Facets“Save Note”: identified as a problem: 30 timesTook 25 minutes to resolve Took 10 minutes to resolveSystem frozen:UM Routing form frozen: identified as a problem : 2 timesFacets frozen: unable to saveSystem froze when attempting to go to CareguideCareguide down x 5All computer programs crashed- had to documentPhysician unable to see baby on G-drive- had “re-pend” 3 timesNo warning screen or notification of a gold carded doctor: Pended to physician by mistake: 2 timesLetter template errors: Identified by UM Rns 3 timesDouble clicking address fixesLetter builder problemCM: RN- Has to adjust address to fit into envelope window properlyCM- letters are not in alphabetical orderService screen: Delete diagnosis when trying to add additional diagnoses.PC problems:screens open and close : identified: 10 timesPC computer: freezePC computer: shutdownICD search less sensitive to spelling errorsLoaded inpatient but caller wants observation: Multiple changes to screen, overrides, etc.System application: Problem with CM member referral screenSystem Applications: Problem with address x 2.Fax issues: ( identified: 50)Some specifically identified issuesFaxes upside down: 4 times (identified by CM as well)Fax screen issues: 37 timesDuplication of Information: identified (identified: 474)CM complexity and in notesCopy/paste: (identified 533 times)UM inquiry bucket – tedious clerical work. Problems identified beyond UM process:Appeals Nurse: 470 problems identified in 3 shifts. 1) Majority of problems: copy/paste (341). i) Copy and paste required to be use Milliman guideline wording.2) Clocking or slow Facets (reported 3 times)II. Appeals tech: 30 problems reported in 8 shifts .Majority of problems identified: waiting in line for the copier: 14 timesFacets clocking.III. Problems identified by Case Management through observations: ( 3 Case managers have identified 386 problems over 12 total shifts)\sFACETS:If phone number is wrong, can correct in Care Advance but not in Facets.Can’t pull up out of pocket maximumGot diagnosis code: 584 but invalid number of digits when putting into Facets.Facets slow : reported 6 times : descriptions:Facets hanging up multiple timesFacets stalling againFacets clocking: 2 minutesFacets clocking: 1 minuteFacets locking up: 4 minutesSystem clocking 3 minutes : sign out and in.Clocking 1 minute then stopped. CARE ADVANCESystem design: In Care Advance phone log: cannot tell if previously spoke to person or not, have to click on each individual line to find out in progress notes.Edit timing for a milestone is time consuming (Reported by 4 RNs)“Advanced Options fixed works sometimes but not others have to checkCannot punch one button and update all goalsExtra step with Care plan goals. 3) Cannot copy with mouse depending on the document 4) Cannot go from Care Plan to Progress notes. (Back out identified as a problem 110 times) 5) CM nurses “skip” page that are suggestions for other assessment 6) “Skip :”gaps in care”Cases: work assignments only come up 10 at a timeA lot of steps to change short term goal to long term. (Reported 6 times) description: “Milestone properties is the only way to change short/ long term goal status”Member phone number not on main member overview page- extra work looking for it in case properties description box.Phone number listed on personal contacts in Address book.Savings locks out when case is closed.System problems encountered:“Server application error”.Lost work in care Advance- has to go back to reopenClinical doesn’t line up right when copying from Facets into Care AdvanceDifficulty finding a good fit for a goal.Kicked out of “conditions”.Kicked out of Care Advance twiceCare Advance slow. Reported 4 times. 1 description: Took 25 minutes to change dates on 1 member.Found interventions and outcomes were not popping up on task list.Progress note did not appear. Had to get out and in 3 times before it appeared.Assessments:General assessment is not appropriate for certain patients (URAC and NCQA requirement)Pediatric assessment is for well child- gaps in care are not appropriate for NICU patient.Format for DM survey requires information that may not be able to be obtained.OTHER Has to reset printer every day from “Universal printer”: Got Help desk to fix.On a fax, the right scroll button disappeared, had to reopen to fix it. Letters are not in alphabetical order.No internal BCBST phone book.Copy/paste did not work. Second screen monitor not working ( reported 3 times- had to reboot spent 7 minutes rebooting one of the times) VII. Facets is member ID number driven but Care Advance is name driven. (The only place in Care Advance that the member ID # can be found is on the member overview screen.) ................
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